Utilities of scrotal flap for reconstruction of penile skin defects after severe burn injury

Summary: Reconstruction of tissue defects resulting from high-voltage injuries remains a serious issue in plastic surgery. For many years it has been solved by applying autologous reconstruction with rotated and revascularized flaps. We present a series outlining reconstructive practices in treatment of patients with high-voltage “uromanual” injuries. These types of injuries include a group of upper extremities and genitoperineal high-voltage trauma due to urination on an electrical source, which are rarely discussed in the literature. This study aimed to describe the algorithm of perioperative care and surgical treatment in patients with high-voltage uromanual trauma. Three male patients (mean age 26.3 years, range: 20–35 years) with traumatic injury of the genital area and the upper extremities due to high-voltage injury underwent reconstruction with a one-stage repair of defects. In one patient, the defect of the left upper extremity was eliminated by microsurgical autotransplantation of musculocutaneous thoracodorsal artery perforator flap. The genitoperineal region was repaired using rotated scrotal flaps. In two other cases, phalloplasty with a revascularized myocutaneous thoracodorsal artery perforator flap was followed by urethroplasty with a prefabricated radial forearm free flap. Hand deformities were eliminated using split-thickness skin autografts. All flaps survived. No complications were observed in the autograft harvesting areas. All cases showed good aesthetic and functional postoperative outcomes. Management of uromanual injuries should include one-stage reconstruction of upper extremities and genitoperineal defects for restoration of satisfying functional and aesthetic components crucial for patient’s quality of life and socialization.

show abstract

“…Despite this, scrotal tissues provide excellent elasticity and viability, unlike full-thickness or split- thickness skin autografts. 24 , 25 …”

Section: Discussionmentioning

confidence: 99%

Reconstructive Surgery for High-voltage Injury of Genitoperineal Area and Upper Extremities: The Uromanual Trauma Concept

Adamyan

Aleshina

Abdeeva

et al. 2021

Plastic and Reconstructive Surgery - Global Open

View full text Add to dashboard Cite

show abstract

“…The main drawback of previously described methods for intrascrotal tunneling is the high instances of skin flap necrosis at the penile base after reconstruction. 8 , 12 The classic intrascrotal reconstruction method includes 2 stages of surgery. The primary stage involves surgical denudation of the defected tissues and burying of the exposed deep penile tissues into an intrascrotal tunnel.…”

Section: Discussionmentioning

confidence: 99%

“…Several authors have used the updated knowledge of scrotal anatomy to improve patient care, effectively applying scrotal flaps with axial perfusion in their clinical work. Guo et al 8 provide a series of 17 patients showing the effectiveness of a 2-stage penile reconstruction with scrotal flaps. Pungrasmi et al 9 conducted an anatomical and functional outcomes study after applying a bilateral scrotal flap in penile reconstruction for the treatment of penile foreign-body granuloma.…”

Section: Introductionmentioning

confidence: 99%

Scrotal Tissues: The Perfect Material for Urogenital Reconstruction

Adamyan

Камалов

Ehoyan

et al. 2020

Plastic and Reconstructive Surgery - Global Open

View full text Add to dashboard Cite

Background: Correction of male urogenital pathology of different severity is complicated by the anatomical aspects of the penis. Skin texture, internal structures, and perfusion dynamics of the urogenital area make it a difficult area to reconstruct. We provide our experience with axial scrotal flaps for correction of penile defects of different severity and believe that these local flaps offer sufficient tissue characteristics for proper restoration of this complex region. Methods: Forty-eight patients were divided into 3 groups depending on penile defect genesis and severity. Axial scrotal flap reconstruction was used for the correction of defects in all cases, when necessary in combination with other flaps. Results: Axial scrotal flaps for total and subtotal penile reconstruction serve as valuable material for reconstruction of the urogenital area, and are to be combined with other flaps for restoration of bulk tissues. Localized defects of the penis and urethra reconstructed by axial scrotal flaps provide excellent aesthetic results with minimal scaring, stable perfusion dynamics, and high satisfaction rate. Conclusions: Scrotal tissues provide an excellent reconstruction material for penile defects because of their highly similar tissue structure as that of the penis. Scrotal axial flaps do not provide excess bulking in the postoperative period and are recommended for reconstruction of urethral and localized penile defects. Multistage surgery is recommended in cases of severe tissue damage, in combination with other flaps (inguinal, thoracodorsal, and radial).

show abstract

“…Kim et al (16) noted that perforator flap reconstruction is an ideal procedure for the repair and reconstruction of the perineum. Furthermore, since skin in scrotal area is similar to the penis in texture, thickness, and ductility, it plays a particular role in the penis skin defect reconstruction (20)(21)(22). Based on the features, we used the scrotal skin flap to repair the penile area while the perforator flap to repair circum-penoscrotal skin area, and achieved ideal outcome.…”

Section: Discussionmentioning

confidence: 99%

Divisional Reconstruction Strategy: The Repair of Perineal Skin Defect After Tumor Resection

Dai

et al. 2020

Scand J Surg

View full text Add to dashboard Cite

Background and Aims: The unique anatomical and physiological function of the perineum region makes it difficult to be repaired after tumor resection. We aim to evaluate the efficacy of PSC divisional reconstruction strategy in the reconstruction of perineal skin defect. Materials and Methods: This study includes patients undergoing perineal skin defect reconstruction with PSC strategy—P (penis), S (scrotum), C (circum-penoscrotal skin) divisional reconstruction strategy. Results: From August 2013 to August 2018, 47 patients were enrolled in the surgical procedure. The defect area after resection measured 2 cm × 2.5 cm, minimum, and 12 cm × 18 cm, maximum. Among them, the cases involved one, two, and three zones are 12, 10, and 25, respectively. The skin defects were divisionally repaired. All flaps were well survived without complications or scar contracture. No tumor recurrence happened. Conclusion: The application of PSC divisional reconstruction strategy is a promising way to repair wounds in circum-penoscrotal skin area. Moreover, this strategy is easy to process and shows no significant complications during follow-up period.

show abstract

Utilities of scrotal flap for reconstruction of penile skin defects after severe burn injury

Cited by 19 publications

References 30 publications

Reconstructive Surgery for High-voltage Injury of Genitoperineal Area and Upper Extremities: The Uromanual Trauma Concept

Reconstructive Surgery for High-voltage Injury of Genitoperineal Area and Upper Extremities: The Uromanual Trauma Concept

Scrotal Tissues: The Perfect Material for Urogenital Reconstruction

Divisional Reconstruction Strategy: The Repair of Perineal Skin Defect After Tumor Resection

Contact Info

Product

Resources

About